South African Journal of Child Health - Volume 3, Issue 3, 2009
Volume 3, Issue 3, 2009
Source: South African Journal of Child Health 3, pp 71 –72 (2009)More Less
In summary, almost 50 000 newborn and child lives could be saved in the year 2015 if South Africa reached high, effective coverage, especially of PMTCT and newborn care. This would put South Africa right on target for MDG 4 (Fig. 1), and also contribute significantly to progress for maternal health (MDG 5). However, to save these lives in the real world of the South African health system, the challenge is to ensure not only high coverage for all but also higher-quality coverage. Too often the high-impact interventions are being performed sub-optimally. For example, even though more than 90% of women complete at least one antenatal visit a recent assessment showed that only about 11% received the full set of interventions required.
Source: South African Journal of Child Health 3, pp 73 –77 (2009)More Less
Background. Pulmonary function tests (PFTs) objectively measure the extent and progression of cystic fibrosis (CF) lung disease. The rate of lung function decline in developing countries has not previously been studied.
Aim. To investigate the average annual rates of pulmonary function decline in South African children with CF from 1999 to 2006.
Methodology: The medical records and best PFT over 3-monthly intervals of children attending the CF clinic at Red Cross War Memorial Children's Hospital, Cape Town, were retrospectively reviewed and analysed using the mixed model regression method.
Results. A total of 1 139 PFT were recorded on 79 patients, with a median (interquartile range) of 14 (6 - 21) PFTs per patient. The mean (standard error) forced expiratory volume in 1 second (FEV1) at age 6 years was estimated at 73.83 (3.34) per cent predicted with an FEV1 decline of 0.23 (0.43)% per annum. FEV1 at age 6 was affected by age at CF diagnosis, genotype, and year of birth. Rate of FEV1 decline was significantly affected by Pseudomonas aeruginosa colonisation and genotype.
Conclusions. Although FEV1 at age 6 years was low compared with developed countries, the annual rate of FEV1 decline in South African children with CF was minimal, setting the scene for improved survival in this population.
Source: South African Journal of Child Health 3, pp 80 –82 (2009)More Less
Background. The impact of tuberculosis (TB) is highest in the developing countries of Asia and Africa, especially among children, in whom the diagnosis is challenging. Periodic skin testing by the Mantoux method is recommended in children living in regions of high TB prevalence.
Objective. To determine the prevalence of Mantoux test positivity among bacille Calmette-Guérin (BCG)-vaccinated and nonvaccinated children aged under 5 in Maiduguri, Nigeria.
Method. The study was descriptive and cross-sectional, conducted in 500 apparently healthy children aged 3 - 59 months and attending the child welfare clinics of the University of Maiduguri Teaching Hospital and two primary health care centres in Maiduguri, Nigeria, from May to August 2008. All children who fulfilled the inclusion criteria were evaluated for a history of BCG vaccination and Mantoux tested.
Results. It was possible to perform a Mantoux reading in 78.0% (390/500) of the children. Of these 201 (51.5%) were males and 189 (48.5%) females (male / female ratio 1.1:1). Thirty-one of the 390 children (7.9%) had a positive Mantoux reaction, 27 (87.1%) with an induration of 10 - 14 mm and the remaining 4 (12.9%) with an induration of 15 - 20 mm. The prevalence of Mantoux positivity was higher among vaccinated than non-vaccinated children (10.1% v. 1.1%, p=0.0034). Differences were also observed between the sexes (p=0.087) and between different age groups (p=0.159), but these were not significant.
Conclusion. Although a positive Mantoux response is usually attributed to TB infection, the effect of previous BCG vaccination on Mantoux test reactivity, especially in children, should be taken into consideration when interpreting Mantoux test responses.
Delivery of the Nutrition Supplementation Programme in the Cape Town metropolitan area from the perspective of mothers of under-5s : a qualitative studySource: South African Journal of Child Health 3, pp 83 –95 (2009)More Less
Background. Child malnutrition is a major problem in South Africa despite implementation of various policies and programmes. Ideally these programmes should be delivered within a human rights paradigm, i.e. parents are responsible for their children's health, while the State authority is obliged to help parents meet their responsibility. The Nutrition Supplementation Programme (NSP) aims to help underweight children gain weight and empower parents to tackle malnutrition.
Objective. To study mothers' experience with the NSP, and assess this in relation to South Africa's emphasis on human rights.
Subjects and methods. Seven focus group discussions were conducted with a total of 28 mothers of under-5s included in the NSP. The methodology used is particularly suitable for disclosing unexplored and unexpected issues.
Results. Most mothers expressed satisfaction with receiving the supplements, which they perceived to be nutritious. However, they had received little or no education and lacked knowledge and skills regarding how to help their children gain weight. In addition, many mothers had experienced poor communication with staff members as well as unfavourable comments and lack of respect. These experiences and perceptions were real for mothers and indicate that the way the NSP was delivered resulted in inadequate compliance with certain principles of human rights, especially respect for human dignity, client participation and empowerment.
Conclusions. Even though small studies are relatively prone to bias, this qualitative study is informative. More focus on the education part of the NSP would enable mothers to manage their children's nutrition better. Measures to improve health workers' knowledge of how to work within a human rights paradigm are necessary in order to strengthen accountability of the health authorities and improve children's health.
Medication use and abuse in childhood diarrhoeal diseases by caregivers reporting to a Nigerian tertiary health institutionSource: South African Journal of Child Health 3, pp 83 –89 (2009)More Less
Background. Childhood diarrhoeal diseases have a major impact on morbidity and mortality. Prompt and appropriate interventions improve outcome.
Objectives. To evaluate the practice of mothers/caregivers with respect to use of antibacterial and antimotility drugs.
Methods. Caregivers of under-5s presenting from catchment areas of the University of Nigeria Teaching Hospital between October 2006 and February 2007 were interviewed by means of a structured questionnaire. Data obtained included perception of cause of diarrhoea, use of oral rehydration therapy (ORT) fluids, and use of antibacterial and antimotility drugs.
Results. Caregivers of 156 children met the inclusion criteria. Most mothers (53%) believed that the diarrhoea was caused by teething and 51% had used antibiotics (the commonest was metronidazole). Use of antibiotics was not influenced by the perceived cause of diarrhoea, level of maternal education or social status. Drug use delayed the time of presentation and was associated with more severe dehydration.
Conclusion. We found that home treatment of acute diarrhoea is characterised by unnecessary use of antibiotics and antidiarrhoeal agents. Intermittent public health campaigns and health care worker updates on the use of ORT and zinc supplements are needed. The latter may also satisfy caregivers' urge to give 'medicine' while at the same time reducing antibiotic abuse and drug resistance.
Source: South African Journal of Child Health 3, pp 96 –97 (2009)More Less
Abdominal epilepsy is an exceptionally rare cause of abdominal pain that is more likely to occur in children than in adults. We report on a child with episodic paroxysmal abdominal pain, accompanied by flatulence, neck pain, tiredness and bilateral weakness of the lower limbs. The findings on physical examination were normal except for Mongolian spots. Haematological investigations, radiographs and an ultrasound scan were normal. The electro-encephalogram showed temporal lobe dysrhythmia during a typical attack. The patient responded well to carbamazepine and remained asymptomatic during the 6 months prior to our writing this article, while taking her treatment regularly.
Initial treatment of severe malaria in Cameroonian children - likely problems of inadequate, improper, delayed or failed treatment : letterSource: South African Journal of Child Health 3, pp 98 –99 (2009)More Less
We read the recent article by Chiabi et al. with keen interest and some surprise. Pre-admission medications were reportedly used for 287 patients (97%), of whom 59% (170) had used some form of antimalarials. Poor knowledge on the part of the mothers on how to identify the signs and symptoms of malaria and their inability to differentiate malaria from other causes of childhood fever might explain the non-treatment of a significant number of the patients before hospital admission.